A survey of more than 4,100 healthcare personnel (HCP) at a New York healthcare system from 2021 to 2022 reveals that 17% were hesitant to receive the recommended COVID-19 vaccine booster, and 33% were unsure about vaccinating their children.
Many of the HCP polled held unsubstantiated beliefs not only about COVID vaccines but also childhood vaccines.
Almost two-thirds had patient contact
The Northwell Health–led study, published in Vaccine, involved 4,165 HCP who completed the mandatory COVID-19 primary vaccine series, had intact immune systems, and took electronic surveys from December 2021 to January 2022. The aim was to identify links between sociodemographic and employment factors and perceptions of COVID-19 vaccines among HCP overall and a subset who had children.
New York state mandated that all HCP, regardless of job role and title, receive the first dose of the primary COVID-19 vaccine series by September 27, 2021, as a requirement for employment. During the study period, the booster dose was recommended but not mandated.
Respondents were primarily women (83.1%), and age, race, and languages spoken were evenly distributed. Of the respondents, 42.4% had high patient contact, and 22.9% had some contact. The largest percentages of HCP were nurses (26.0%), clinicians (10.5%), and other providers (4.4%).
Worries about vaccine safety, efficacy
An estimated 17.2% of administrative and clinical HCP were hesitant to receive the state-recommended COVID-19 vaccine booster, and 32.6% were unsure about having their children vaccinated, regardless of whether the HCP had a clinical role.
A large proportion of respondents were unsure about the COVID-19 vaccine's effects on infertility (33.3%), miscarriage (37.0%), DNA changes (23.1%), and immune response (21.7%). A total of 46.4% were unsure about any link between COVID-19 vaccines and myocarditis, and 47.0% were moderately to extremely confident about discussing common vaccine concerns.
A small fraction of HCP (6.9%) said childhood vaccines were unsafe and that the risks didn't outweigh the benefits (2.5%) and didn't prevent disease (2.6 %).
The vast majority (85.3%) said COVID-19 vaccination was important to them, 60.0% indicated that their strong recommendation for vaccination would affect a patient's decision to vaccinate, and 68.0% said the COVID-19 vaccine, based on US Food and Drug Administration emergency use authorization, was safe for children.
In total, 64.9% of HCP with children and 70.1% without children received a booster dose—a higher rate than in the general population during the study period.
A small fraction of HCP (6.9%) said childhood vaccines were unsafe and that the risks didn't outweigh the benefits (2.5%) and didn't prevent disease (2.6 %). A third of respondents (32.8%) said the current childhood vaccination schedule was too taxing on a child's immune system.
Overall, 45.0% of HCP indicated that parents should decide whether vaccines are given to their children, even if their opinions and beliefs countered scientific evidence on vaccinations, and 61.0% said delaying recommended vaccines for several visits after their recommended schedule was OK. In total, 30.0% believed that parents and caregivers should be able to request nonmedical exemptions for school entry.
HCPs who were not parents were much less likely than parents to hesitate about vaccinating themselves (prevalence ratio [PR], 0.61), and a significant percentage of parents of children older than 5 years were reluctant to vaccinate their children in general (PR, 1.15). Of respondents with vaccinated children of any age, hesitancy was about half that of those with unvaccinated children (PR, 0.52 for parents of children aged 5 to 11 years; PR, 0.58 for parents of children aged 12 to 17 years).
HCP hesitancy compromises patient care
Regression analyses indicated that Black (PR, 1.35), Hispanic (PR, 1.35), and American Indian/Alaska Native (PR, 1.74) HCPs were about 1.5 times more likely, and White (PR, 0.63) and Asian (PR, 0.53) respondents were about half as likely, to be vaccine-hesitant than multiracial HPCs.
Women and respondents who were younger, earned lower incomes, had fewer years on the job, lived in Manhattan, and hadn't previously received a COVID-19 booster were significantly more likely to be vaccine-hesitant. Bilingual respondents were 2.5 times more likely to be vaccine-hesitant than English-only speakers.
High vaccine hesitancy among HCP for COVID-19 vaccination and booster doses parallels high vaccine hesitancy for pediatric COVID-19 vaccination, thereby having a downstream community impact.
The study authors noted that while HCP recommendation has been the main method of overcoming patient COVID-19 hesitancy, understanding vaccine reluctance requires a more integrated rather than a "top-down" approach, because HCPs are more hesitant than ever about vaccination.
"Provider recommendation is compromised at point of care when surrounding HCP, despite having already received their standard COVID-19 doses, still question the need for vaccination and subsequent booster doses," they wrote. "Furthermore, high vaccine hesitancy among HCP for COVID-19 vaccination and booster doses parallels high vaccine hesitancy for pediatric COVID-19 vaccination, thereby having a downstream community impact."
A more grass-roots approach to HCP education is needed: "Our next step is to reach out to focus groups volunteered from this survey population and determine if this subpopulation will be instrumental in developing training modules for COVID-19 vaccination. As the pandemic continues to evolve into endemic status, our global approach to vaccine hesitancy requires diversification, innovation, and approaches yet to be discovered."
